Pyelonephritis is an inflammation of the renal parenchyma, renal pelvis and calyces. Typically, the disease is caused by a bacterial infection common in the urinary tract or kidneys.

Pyelitis (inflammation of the pelvis and calyces) with nephritis constitute pyelonephritis. In severe cases pyelonephritis is very dangerous and can lead to pyonephrosis (accumulation of pus around the kidney), urosepsis (systemic inflammatory response to infection), and renal failure.
Pyelonephritis has symptoms such as fever, rapid heart rate, painful urination, abdominal pain radiating to the back, nausea in the costovertebral angle. Pyelonephritis, urosepsis under be accompanied by symptoms of septic shock, including rapid breathing, blood pressure decreasing.

Acute pyelonephritis is exudative purulent inflammation of the renal pelvis and kidney.
Chronic pyelonephritis infection involves a kidney, and can lead to scarring of the kidney parenchyma and the disturbance function, particularly under conditions of obstruction. In severe cases of pyelonephritis may develop kidney abscess (inflammation around the kidney) or pyonephrosis.
Xanthogranulomatous pyelonephritis is a rare and unusual form of chronic pyelonephritis and characterized by the formation of granulomatous abscess, severe renal failure and its clinical picture may resemble renal cell cancer and other inflammatory parenchymal renal disease. This disease is about 20% of the total number of cases of pyelonephritis.


Signs and symptoms of pyelonephritis
Symptoms of acute pyelonephritis usually quickly develop within a few hours or days. This can lead to a high temperature, pain during urination, and abdominal pain. Appears frequently vomiting.
In chronic pyelonephritis occur constant abdominal pain, signs of infection (fever, unintentional weight loss, malaise, loss of appetite), lower urinary tract symptoms and blood in the urine. Furthermore, due to the inflammation blood-related proteins can be accumulated, which causes amyloidosis.


Causes of pyelonephritis
In most cases part of pyelonephritis intestinal organisms, which fall into the urinary tract. Common organisms are E. coli (70-80%) and Enterococcus faecalis. If pyelonephritis part of nosocomial infection, it may be E. coli and enterococci, as well as other rare organisms (Pseudomonas aeruginosa and different types of Klebsiella). In most cases, pyelonephritis begins as an infection of the lower urinary tract, mainly cystitis and prostatitis. Escherichia coli can penetrate into superficial cells of the bladder to form an intracellular bacterial colonies which are able to mature biofilm. These biofilms are resistant to antibiotic therapy and immune reactions
Risk factors can also be: any structural abnormalities in the urinary tract, PMR (urine from the bladder into the ureter hits back), kidney stones, urinary tract catheterization, ureteral stenting or drainage procedures (eg nephrostomy), pregnancy, neurogenic bladder (eg due to spinal cord injury, spina bifida or multiple sclerosis) and prostate disease (eg benign prostatic hyperplasia), diabetes, a weakened immune system, a change in sexual partner in the last year, use of a spermicide, a positive family history (close family members with frequent urinary tract infections).


Diagnosis of pyelonephritis
Urinalysis can detect signs of urinary tract infection. In particular, the presence of nitrites and white blood cells in patients with typical symptoms are sufficient for the diagnosis of pyelonephritis, and are an indication for empirical therapy. Blood tests such as complete blood count may reveal neutrophilia. Microbiological analyzes of urine, with or without blood cultures, and sensitivity to antibiotics can be used to make an accurate diagnosis, and are mandatory.


If there is suspicion of a kidney stone (for example, by identifying the presence of colic or disproportionately large amount of blood in the urine), the visual diagnostic procedure CT is used for kidney, ureter, bladder. All stones are detected on CT, except in very rare stones composed of certain drug residues in the urine. In patients with recurrent urinary tract infections, it may be necessary to exclude anatomical abnormalities, such as polycystic kidney disease or PMR. The surveys used in this situation include renal ultrasonography or voiding cystourethrography, CT or abdominal ultrasound is also used in the diagnosis of xanthogranulomatous pyelonephritis, and to prevent kidney cancer.


Recently, the most reliable test for the diagnosis of acute pyelonephritis is a scan DMSA, at which to evaluate renal morphology used dimercaptosuccinic acid.


Treatment of pyelonephritis
In patients with suspected pyelonephritis, performed urine culture and sensitivity analysis to antibiotics, and initial therapy is designed on the basis of the infecting organism. Since, in most cases, pyelonephritis caused by bacterial infections, antibiotics are the mainstay of treatment. The choice of antibiotic depends on the type and sensitivity profile of the pathogen, and is determined only by an experienced physician.


In more severe cases may require other types intravenous antibiotics are also determined by the physician based on an accurate diagnosis in Israel. The treatment regimen is selected based on local data and the resistance profile of the particular susceptibility of the infecting organism.


In Israel for the treatment of pyelonephritis are only the latest generation of antibiotics.


During the course of antibiotic treatment, requires constant monitoring the number of leukocytes in the blood and body temperature. In cases of obstruction caused by stones can be shown percutaneous nephrostomy or ureteral stenting, to remove the obstruction.


Sometimes for the treatment of pyelonephritis and require surgical intervention, such as ureteroscopy, percutaneous nephrostomy or percutaneous nephrolithotomy.


In such rare chronic forms as xanthogranulomatous pyelonephritis may be recommended laparoscopic nephrectomy (removal of the kidney). This can only be determined by an experienced physician.
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